Combined IV-intra-arterial thrombolysis: a color-coded duplex pilot study

Area of Science:

• Neuroscience
• Vascular Neurology
• Medical Imaging

Background:

• Stroke is a leading cause of disability.
• Timely recanalization of occluded cerebral arteries is crucial for improving outcomes.
• Intravenous thrombolysis (IVT) is a standard treatment, but its efficacy is limited in severe occlusions.

Purpose of the Study:

• To compare the effectiveness of combined intravenous-intra-arterial (IV-IA) thrombolysis versus IV thrombolysis alone.
• To evaluate changes in transcranial color-coded duplex (TCCD) patterns of middle cerebral arteries (MCAs) post-thrombolysis.
• To assess the incidence of complete MCA recanalization in first-ever stroke patients.

Main Methods:

• Consecutive first-ever stroke patients were included.
• TCCD was used to assess MCA blood flow patterns before and after treatment.
• Patients received either IV thrombolysis or combined IV-IA thrombolysis.

Main Results:

• Combined IV-IA thrombolysis demonstrated greater improvement in MCA flow signals compared to IV thrombolysis.
• A higher incidence of complete MCA recanalization was observed with combined IV-IA thrombolysis.
• These benefits were particularly pronounced in patients with occluded or minimally flowing MCAs.

Conclusions:

• Combined IV-IA thrombolysis is more effective than IV thrombolysis alone for achieving MCA recanalization in acute stroke.
• TCCD is a valuable tool for monitoring treatment response and assessing recanalization.
• The findings support the use of combined IV-IA thrombolysis for severe MCA occlusions.